TY  - JOUR
PY  - 2023//
TI  - Emergency department pediatric readiness and short-term and long-term mortality among children receiving emergency care
JO  - JAMA network open
A1  - Newgard, Craig D.
A1  - Lin, Amber
A1  - Malveau, Susan
A1  - Cook, Jennifer N. B.
A1  - Smith, McKenna
A1  - Kuppermann, Nathan
A1  - Remick, Katherine E.
A1  - Gausche-Hill, Marianne
A1  - Goldhaber-Fiebert, Jeremy
A1  - Burd, Randall S.
A1  - Hewes, Hilary A.
A1  - Salvi, Apoorva
A1  - Xin, Haichang
A1  - Ames, Stefanie G.
A1  - Jenkins, Peter C.
A1  - Marin, Jennifer
A1  - Hansen, Matthew
A1  - Glass, Nina E.
A1  - Nathens, Avery B.
A1  - McConnell, K. John
A1  - Dai, Mengtao
A1  - Carr, Brendan
A1  - Ford, Rachel
A1  - Yanez, Davis
A1  - Babcock, Sean R.
A1  - Lang, Benjamin
A1  - Mann, N. Clay
SP  - e2250941
EP  - e2250941
VL  - 6
IS  - 1
N2  - IMPORTANCE: Emergency departments (EDs) with high pediatric readiness (coordination, personnel, quality improvement, safety, policies, and equipment) are associated with lower mortality among children with critical illness and those admitted to trauma centers, but the benefit among children with more diverse clinical conditions is unknown. <br><br>OBJECTIVE: To evaluate the association between ED pediatric readiness, in-hospital mortality, and 1-year mortality among injured and medically ill children receiving emergency care in 11 states.     DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study of children receiving emergency care at 983 EDs in 11 states from January 1, 2012, through December 31, 2017, with follow-up for a subset of children through December 31, 2018. Participants included children younger than 18 years admitted, transferred to another hospital, or dying in the ED, stratified by injury vs medical conditions. Data analysis was performed from November 1, 2021, through June 30, 2022.     EXPOSURE: ED pediatric readiness of the initial ED, measured through the weighted Pediatric Readiness Score (wPRS; range, 0-100) from the 2013 National Pediatric Readiness Project assessment.     MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality, with a secondary outcome of time to death to 1 year among children in 6 states. <br><br>RESULTS: There were 796 937 children, including 90 963 (11.4%) in the injury cohort (mean [SD] age, 9.3 [5.8] years; median [IQR] age, 10 [4-15] years; 33 516 [36.8%] female; 1820 [2.0%] deaths) and 705 974 (88.6%) in the medical cohort (mean [SD] age, 5.8 [6.1] years; median [IQR] age, 3 [0-12] years; 329 829 [46.7%] female, 7688 [1.1%] deaths). Among the 983 EDs, the median (IQR) wPRS was 73 (59-87). Compared with EDs in the lowest quartile of ED readiness (quartile 1, wPRS of 0-58), initial care in a quartile 4 ED (wPRS of 88-100) was associated with 60% lower in-hospital mortality among injured children (adjusted odds ratio, 0.40; 95% CI, 0.26-0.60) and 76% lower mortality among medical children (adjusted odds ratio, 0.24; 95% CI, 0.17-0.34). Among 545 921 children followed to 1 year, the adjusted hazard ratio of death in quartile 4 EDs was 0.59 (95% CI, 0.42-0.84) for injured children and 0.34 (95% CI, 0.25-0.45) for medical children. If all EDs were in the highest quartile of pediatric readiness, an estimated 288 injury deaths (95% CI, 281-297 injury deaths) and 1154 medical deaths (95% CI, 1150-1159 medical deaths) may have been prevented. <br><br>CONCLUSIONS AND RELEVANCE: These findings suggest that children with injuries and medical conditions treated in EDs with high pediatric readiness had lower mortality during hospitalization and to 1 year.<p />  <p>Language: en</p>
LA  - en
SN  - 2574-3805
UR  - http://dx.doi.org/10.1001/jamanetworkopen.2022.50941
ID  - ref1
ER  -